Are we going “co‐crazy”? An opportunity to learn from health promotion foundations

Over the past few months, multiple members of the editorial team of the Health Promotion Journal of Australia (HPJA) have been privileged to attend the Australian Health Promotion Association (AHPA) National Health Promotion Symposium and the Australasian Evaluation Society's 2018 International Evaluation Conference. We noted a common theme—a deep interest in partnerships and an imperative to work collaboratively to achieve better health, social and economic outcomes at a population level. These concepts resonated with our professional understandings of health promotion—that is, exemplary health promotion involves effective partnerships and strong collaboration.1-3 This concept is not new. Working in partnership is deeply enshrined in the Declaration of Alma-Ata and Ottawa Charter—it is a principle that has underpinned community development, health promotion, public health and comprehensive primary health care approaches for decades.4-6 Such principles are now also firmly embedded in global health promotion competencies, such as those that underpin the Health Promotion Practitioner Registration system currently being implemented by the AHPA.7, 8 Also, intersectoral collaboration is considered a fundamental principle for steering health promotion efforts involving action on the social determinants of health.2, 3 In many respects, working collaboratively is what health promoters do well and is reflected in the multiple articles that have been, and continue to be, published in HPJA. Recent contributions have related to obesity prevention,9 breastfeeding,10 healthy environments11 and mental health,12 to name a few. However, during our recent conference experiences, it was evident that we have entered a new era in the way partnerships and collaborations are expressed. We heard about the importance of co-planning, co-creating, co-designing, co-producing, co-disseminating and co-evaluating.13, 14 It appears we are going “co-crazy” in the way we describe the processes and work that we do. We are not dismissing the terms. Indeed, in recent times, many members of the editorial team have either facilitated or participated in workshops or projects underpinned by this “co” thinking approach. We do, however, consider this discourse is entirely synergistic with the underlying principles of health promotion. Furthermore, the “co” approach is a well-used concept in equity research, and a necessary approach when working with Indigenous peoples.15, 16 Essentially, these are new terms to explain familiar concepts. A defining feature of the shift in discourse from “collaboration” and “partnerships” to all-things “co” is the significant policy and practice traction it has gained in a relatively short time frame. It draws heavily on participatory design and design thinking.17, 18 This language is being adopted by the state and national governments, non-government organisations, private enterprises and philanthropic funders.18 The promise of co-design is expansive. It is increasingly being espoused as an expectation in consultation and needs assessment work; embedded into commissioning and contracting processes; described as best practice in emerging monitoring and evaluation frameworks; and outlined as a preferred way of engagement in health strategies and policies.16 We have also seen the emergence of online tools to support co-design(ed) initiatives, particularly linked to projects with a social service orientation. See, for example, the Health Service Co-design19 work emanating from New Zealand, or the Experienced Based Co-design Toolkit20 developed for the Australian Healthcare and Hospitals Association and the Consumers Health Forum of Australia. The seasoned health promoter among us is likely to recognise this new “co” lexicon as something we have done for decades. It is about working together. It is reflective of good, solid, health promotion practice underpinned by genuine and effective partnership development and collaboration at all stages of planning, implementation and evaluation.1 So why describe it differently? A multitude of social innovation, social impact and social enterprise organisations have already successfully embraced the “co-crazy” era to undertake innovative work that could equally be termed health promotion. The people working for these organisations often appear to have strong health promotion or public health backgrounds, indicating that partnership development skill sets are highly valued and transferable to a broad range of social, economic and political contexts. In many ways, it is pleasing to see that the co-design discourses have been so easily adopted across multiple sectors, demonstrating it has a certain universal appeal. At a time when we have seen significant disinvestment in health promotion in Australia,21, 22 it seems sensible for the health promotion community to embrace, rather than resist, the “co-crazy” jargon. We know that the health promotion policy landscape is susceptible to the ebbs and flows of political cycles. We also know that the terminology used to describe the work which we undertake is equally susceptible to change. The “co-crazy” era is one such example. As health promoters, we are being asked to make a choice. We can continue using terms such as “partnerships” and “collaboration” that have a legacy, value-base and professional foundation that has served us well for decades. Or we can embrace change and jump on the “co-crazy” bandwagon to further contemporary health promotion agendas. We know health promoters are adept at adapting. So perhaps it is not an either or scenario—we can do both. The online Collins dictionary informs us that the prefix “co” refers to people doing or sharing things; whereas partnership perhaps refers more to the relationships between people that facilitates and sustains the doing and sharing that is so integral to health promotion. Whether you have a preference for “collaborative,” “partnership” or “co-crazy” speak, it pays not to be precious about the terms we use to describe the work we do. Instead, we should stay focused on the overarching principles and values that underpin health promotion practice. A genuine commitment to work together, and embrace the lived-experience of citizens, will continue to put us in good stead to improve population health outcomes and health equity across the region. The authors declare that there are no conflicts of interest in connection with this article.